Provider Demographics
NPI:1316765878
Name:300 PEARL STREET OPCO LLC
Entity type:Organization
Organization Name:300 PEARL STREET OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:YEHUDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-430-5735
Mailing Address - Street 1:290 CENTRAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-8507
Mailing Address - Country:US
Mailing Address - Phone:516-430-5735
Mailing Address - Fax:781-729-3817
Practice Address - Street 1:300 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8531
Practice Address - Country:US
Practice Address - Phone:802-658-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility